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Click here or scroll down to respond to this candidateCandidate's Name
Gainesville, FL PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional SummaryHighly organized, multifaceted professional with extensive experience in all aspects of billing and payroll management, administrative operations, accounts receivable processing, and medical claims reimbursement. Recently earned a Masters in Data Analytics and looking to diversify into a data analytics position to:Analytical and Strategic Manager: Expert at billing and reimbursement management, insurance claims, client eligibility; and overseeing payroll discrepancies and pay rate changes following medical billing practices.Hands-on and Communicative Leader: Effective at guiding and supervising cross-functional teams and personnel, building strong rapport, and working collaboratively with payers, office staff, providers, government, third-party insurance companies, and diverse individuals.EducationPurdue University Global Master of Science in Data Analytics September 2023 Python, Google Colab, Tableau, Data Curation, Machine Learning, Deep Learning, and Statistics GPA 4.0 Polytechnic University - Bachelor of Science in Computer Science/Computer Engineering May 1987 Minor in MathematicsTechnical Skills Python RStudio, SQL, Statistics SQL Microsoft Office Statistics Tableauo Excel (Functions, Formulas, and Formatting)o Wordo Outlooko PowerPoint RStudio Power BI Collaboration and Communication Analytical and QuantitativeTableau: https://public.tableau.com/authoring/ProfitComparisonStatesProductandQuantity/ProfitComparison#1 Work HistoryBilling and Reimbursement Coordinator All Physical Medicine and Rehabilitation Gainesville, FL 04/2023 Present Billing of all claims for all insurances including Medicare, Medicaid, Managed Medicare and Medicaids, BCBS, Humana, Aetna, Cigna, Worker's Compensation, Auto Claims, and many others Eligibility and compensation reviews are maintained on a weekly basis Assist in the authorization process by contacting PCP for necessary referrals and authorizations Maintain participating and non-participating provider records in the provider database Resolve provider-related issues for denied claims Notifies personnel and clients of changes that may affect the claims process Researched and resolved rejected claims by correcting and resubmitting as appropriate Ensure work is completed promptly Complete continued training as neededBilling Payroll Manager/Accounts Receivable Hands from the Heart Home Healthcare Bala Cynwyd, PA 11/2021 to 3/2022 Directly supervised a team of billing specialists, while collaborating with payers for quick and accurate payment of all claims and with program companies to identify the most efficient techniques for issue resolutions using their programs. Successfully checked client eligibility for services performed Guaranteed billable hours are not exceeding authorized hours, as well as managed time and attendance for office staff and imports on payrollAR Advanced Resolution Specialist Envision Healthcare, Inc Conshohocken, PA 02/2017 to 08/2021 Performed research and processing of correspondence regarding all assigned contracted and/or non-contracted carrier and self-pay accounts to guarantee proper payment through reports, spreadsheets (using VLOOKUPs, Pivot Tables, Formulas, etc.), and special projects Held accountability in determining overpayments and incorrect denials from payers to resolve accounts, as well as in administering denial reports and ensuring appropriate documentation of accounts Promptly answered customer service calls and provided a one-time resolution of accounts received Conducted the submission of reconsiderations with appropriate proof to payers, as well as verification / re-verification of the eligibility status of payers and providers to ensure proper payment of claims Thoroughly assessed transmission records to determine and apply corrections on rejected claims for proper submission Independent Contractor SDS Rx King of Prussia, PA 02/2014 to 09/2016 Pharmaceutical inventory management and delivery Reimbursement Specialist (Contract) CardioNet, Inc. Conshohocken, PA 03/2012 to 08/2013 Communicated with insurance and billing companies to identify the mode of payment for services by patient Maintained financial and medical records; coordinated copies of medical documentation in support of medical billing; and processed third-party and Medicare remittances for billing medical claims preparation Analyzed and modified medical claims, edits, and denials to ensure proper payment for medical services rendered Regularly interacted with payers, medical facilities, and hospitals on charge corrections and other claim edits Assumed accountability in processing and posting explanations of benefits (payments or denials); gathering unpaid medical insurance claims in conjunction with insurance providers; and collecting patient documentation Prepared medical reimbursement appeal letters for the resubmission of medical claims with appropriate documentation to overturn, as well as documented daily correspondence to clients Professional DevelopmentNavigating the Medical Record ICD-9 Procedures ICD-9 Coding CPT Procedure Coding, Medical Terminology Outpatient and Physician Office Coding and Billing. Developing and Managing Databases for Business Intelligence, Essentials of Accounting |
